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N E L S O N T AJ O N G, M. D. 690 S Loop 336 W Ste 215 Conroe, TX 77304Name DOB: FAMILY HISTORYSOCIAL HISTORYSTATE OF HEALTHCARE/AGE OF DEATH Mother: Father: Sibling: Sibling: Occupation: Marital
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How to fill out family history social history

01
To fill out family history social history, follow these steps:
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Gather relevant information: Collect information about your family members, including their medical history, social habits, and lifestyle.
03
Document family medical history: Write down any medical conditions that run in your family, such as heart disease, cancer, diabetes, or mental illnesses.
04
Include lifestyle factors: Note any significant social habits or lifestyle choices that may impact health, such as smoking, alcohol consumption, drug use, or exposure to environmental factors.
05
Provide details: Specify the age at which family members were diagnosed with certain conditions, the severity of the conditions, and any treatments they received.
06
Update regularly: Keep the family history social history document up-to-date by adding new information as it becomes available.
07
Share with healthcare providers: Share the completed family history social history with your healthcare providers to help them assess your risk factors and make informed decisions about your healthcare.

Who needs family history social history?

01
Family history social history is beneficial for the following individuals:
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- Individuals seeking personalized healthcare: People who want to receive personalized medical care based on their genetic predispositions and family health patterns.
03
- Individuals with a family history of certain medical conditions: People with a family history of diseases like cancer, heart disease, or diabetes can benefit from understanding their risk factors and taking preventive measures.
04
- Individuals participating in medical research: Researchers studying hereditary diseases and genetic links may require family history social histories to better understand patterns and develop better treatments.
05
- Healthcare providers: Doctors and healthcare professionals use family history social histories to assess patient risk, determine appropriate screenings or interventions, and tailor treatment plans.
06
- Insurance companies: Insurance companies may use family history social histories to assess risk and determine insurance premiums or coverage eligibility.
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Family history social history is a record that gathers information about a person's family background, medical history, and social factors that could influence health.
Typically, individuals seeking medical care, researchers, or healthcare providers may be required to file family history social history to understand potential genetic or hereditary health issues.
To fill out family history social history, one should collect detailed information about their family's health background, including diseases, conditions, and the ages of onset, and document this information in a structured format or form provided by healthcare providers.
The purpose of family history social history is to identify genetic predispositions to certain diseases and to better understand individual health risks based on family background.
Information that must be reported includes the medical conditions of family members, their ages at diagnosis, causes of death, and relevant lifestyle factors or social influences that may affect health.
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